Basic Erosive Wear Examination Score Research Articles

Evaluation of Oral and Dental Health Results and Competition Stress Levels of Adolescent Athletes in Different Winter Sports Branches.

The aim of the present study was to examine the findings of the intraoral examinations of the 12-16 years old novice (control) and elite athletes across the winter sports branches, which were alpine discipline skiing, snowboarding, biathlon, ski jumping, and ice hockey. Besides, the study aimed to determine the intra- and inter-group relationships by comparing the athletes salivary stress biomarker levels at precompetition, during-match, and post-competition stages. Ninety-one athletes (71 elite, 20 novice) participated in our study. Oral health status of the athletes were evaluated. In addition, cortisol levels in the saliva samples obtained at pre-competition (rested before the competition), during-match (just before the start), and post-competition (competition ending moment) stages were measured. The data were analyzed statistically with a significance level of 0.05. Ice hockey athletes were the most affected by untreated dental caries (27.3%). No signs of dental trauma caused by sports activities were found in the winter sports branches. Basic erosive wear examination scores of the ice hockey athletes were similar to the ski jumping athletes and lower than other groups (P=.034). The mean cortisol values between sports branches were listed as: biathlon <snowboarding > alpine skiing < ice hockey < ski jumping (P < .001). Test results of the winter sports athletes' saliva samples revealed that their salivary stress levels might vary in accordance with the sports branches, and there was a negative relationship between the levels of salivary stress biomarkers in competitions and oral health. In winter sports activities, measures for improving oral health should be disseminated.

Association of salivary parameters and erosive tooth wear in preschool children.

The aims of this study were to 1) assess the association between erosive tooth wear (ETW) according to the BEWE (Basic Erosive Wear Examination) scoring system and salivary parameters and 2) compare salivary parameters according to ETW severity in the subgroup of children with ETW. This cross-sectional study included 52 preschool children aged 5 years paired by sex. A calibrated examiner assessed ETW using BEWE criteria, and stimulated saliva was collected to determine salivary flow, osmolality, pH, and buffering capacity. The children were divided into two groups: without ETW (n=26; BEWE score 0) and with ETW (n=26; BEWE scores 1 and 2). Logistic regression analysis was used to determine the magnitude of the association between ETW and salivary parameters and estimates of odds ratios (OR). In the unadjusted analysis, the ETW group was more likely to have lower salivary flow (OR = 0.079; 95%CI = 0.013-0.469; p = 0.005) and lower osmolality (OR = 0.993; 95%CI = 0.985-1.000; p = 0.049). In the adjusted analysis, salivary flow remained significantly associated with ETW (OR = 0.087; 95%CI = 0.014-0.533; p = 0.008). Lower salivary osmolality values were observed in ETW, especially in preschool children with more severe ETW (BEWE score 2). Receiver operating characteristic (ROC) determined a salivary osmolality cutoff point of < 201 for the presence of ETW. In conclusion, salivary flow rate was significantly associated with ETW prevalence. Lower values of salivary osmolality were observed in preschool children with distinct erosive lesions with significant loss of tooth structure (BEWE 2).

Home Oral Care with Biomimetic Hydroxyapatite vs. Conventional Fluoridated Toothpaste for the Remineralization and Desensitizing of White Spot Lesions: Randomized Clinical Trial.

Introduction: Biomimetic hydroxyapatite-based toothpastes have been investigated in recent years for their remineralizing activity on dental surfaces. The aim of the present study was to evaluate the efficacy of toothpaste containing biomimetic hydroxyapatite versus a 1450 pppm fluoride one in promoting the remineralization and desensitization of white spot lesions. Methods: 40 patients were randomly assigned to two different domiciliary oral hygiene treatments: toothpaste containing 1450 ppm of fluoride (control group) and toothpaste containing biomimetic hydroxyapatite (experimental group). Dental sensitivity/pain and dental erosion were assessed at baseline and after 15, 30, and 90 days using the following indexes: Schiff Air Index (SAI), Visual Analogue Scale (VAS), and Basic Erosive Wear Examination (BEWE). Results: Data were submitted for statistical analysis. SAI significantly decreased after 3 months (T3) of treatment only in the Trial group (p < 0.05). VAS values significantly decreased at T2 in the trial group (p < 0.05) with a further significant reduction at T3 (p < 0.05). BEWE scores did not significantly vary during the follow up neither in the trial nor in the control group. Conclusions: The hydroxyapatite-based toothpaste tested caused a reduction of hypersensitivity/pain values higher than conventional fluoride toothpaste.

Dental Erosion in Obese Patients before and after Bariatric Surgery: A Cross-Sectional Study.

Obese patients are at risk of dental erosion due to micronutrient deficiency, consumption of soft drinks, gastric reflux disease and vomiting. The present study evaluates the presence of dental erosion in obese patients before and after bariatric surgery using the BEWE (basic erosive wear examination) scoring system. A total of 62 patients with severe obesity were included in the analysis, 31 in the control group (without bariatric surgery) and 31 in the surgery group (after bariatric surgery). BEWE scores did not vary between groups. Vitamin D deficiency was detected in 19 patients in the control group and three in the surgery group (p < 0.001). The serum calcium and vitamin D values were significantly higher in the surgery group (p = 0.003, p < 0.001 consecutively). All patients after bariatric surgery showed compliance with supplements, including vitamin D and calcium daily. Patients after bariatric surgery were less likely to drink soft drinks regularly (p = 0.026). Obese patients, before or after bariatric surgery, are at risk for erosive dental wear. However, with sufficient education prior to surgery and consistent intake of vitamin and mineral supplements, significant erosive dental wear after bariatric surgery could be avoided. Regular dental examination should be included in the check-up and follow-up program.

Prevalence of erosive wear lesions in Gastro-Esophageal Reflux Disease patients – A case series

Extra esophageal manifestation of Gastro-esophageal reflux disease (GERD) include erosive wear dental lesions. Early erosive wear lesions in this group of patients can be easily missed as they are accompanied by few clinical signs and hardly any symptoms. This case series aims to report the prevalence and severity of erosive wear lesions amongst a sample of GERD patients in Malaysia. Eleven subjects with well characterized GERD, diagnosed based on modified Reflux Disease Questionnaire (RDQ) or via endoscopy, were included in this case series. A standardized intra oral clinical examination was performed to assess presence and severity of erosive wear lesions on tooth surfaces using Basic Erosive Wear Examination (BEWE) index. Majority of BEWE score 1 lesions were distributed in maxillary anterior teeth, followed by maxillary posterior and mandibular teeth. BEWE score 2 lesions were most prevalent in maxillary anterior teeth and there were no BEWE score 3 lesions observed. Based on the clinical findings, more erosive wear lesions were found on the buccal surfaces of maxillary and mandibular teeth in GERD patients. This case series further confirms the link between GERD and erosive wear lesions. The authors would like to highlight the need for both medical and dental practitioners to be aware of early clinical presentations of GERD and erosive wear lesions. Early diagnoses allow for intervention and conservative management of these conditions.

Erosive Tooth Wear and Erosive Esophagitis in Children: An Observational Study in Porto Alegre, Brazil

The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5–12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children’s Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients’ diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0–2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients.

Predictors of dental erosions in patients evaluated with upper digestive endoscopy: a cross-sectional study.

The most studied medical condition related with dental erosions is gastroesophageal reflux disease (GERD). The aim of this study was to assess other predictors of dental erosions besides GERD in outpatients referred for upper digestive endoscopy. In a cross-sectional study, we prospectively evaluated 235 patients who underwent upper digestive endoscopy. Patients were interviewed and examined by a trained dentist before the endoscopies, addressing dental health as well as clinical information and food intake. Dental erosion was classified using Basic Erosive Wear Examination score. Potential predictors for dental erosions were: gender, age, chronic use of antidepressants and proton pump inhibitors (PPI), diabetes mellitus, body mass index, heartburn and acid regurgitation scores, chocolate intake, reflux esophagitis and hiatal hernia. Overall prevalence of dental erosions was 23.4%. The most parsimonious Poisson regression model for dental erosions considered age, chocolate intake and acid regurgitation as predictors. Dental erosions were associated with acid regurgitation in patients younger than 50years [adjusted prevalence ratio (PR) = 1.8 (95% CI 1.1-2.9)] and with chocolate intake in patients older than 50years [PR = 2.1 (95% CI 1.2-3.9]. The surfaces most eroded were palatine/lingual (n = 25) and occlusal (n = 25), followed by vestibular (n = 5). In outpatients evaluated with upper digestive endoscopy, the variables associated with dental erosions were age younger than 50years, acid regurgitation and chocolate intake. Referral for dental evaluation should be considered for young patients with GERD and frequent acid regurgitation.

High serum ferritin levels are associated with a reduced periodontium in women with anorexia nervosa.

Impaired oral health is a well-known complication in individuals with eating disorders, although this is difficult to identify by mental health professionals. The aim of this study was to evaluate the relationship between routine blood parameters and two oral health outcomes (dental erosion, reduced periodontium) in women with eating disorders. A face-to-face interview and a clinical oral examination were carried out in a cohort of 70 women from an addiction and psychiatry hospital unit. Biochemical and hematological parameters were collected in medical records at admission. Biological factors associated with a generalized reduced periodontium (≥ 30% of sites with clinical attachment loss ≥ 3mm) and dental erosion [a basic erosive wear examination (BEWE) score ≥ 3] were determined by logistic regression models. Forty-five women with either anorexia nervosa (n = 27) or bulimia nervosa (n = 18) were included in the study. None of the women had active periodontitis or other inflammatory comorbidity. Women with ≥ 30% of sites with clinical attachment loss ≥ 3mm and those with a BEWE score ≥ 3 were older than women that did not exhibit a generalized reduced periodontium or dental erosion (37.1 ± 10.4 versus 28.8 ± 7.4, p < 0.01 and 35.2 ± 9.7 versus 28.1 ± 7.8, p = 0.01), respectively. After adjustments for age and duration of eating disorder, high serum ferritin levels were associated with a generalized reduced periodontium [OR (95%CI) = 1.04 (1.01; 1.07)]. No association was found between biological factors and dental erosion. Serum ferritin levels together with age may be helpful to mental health professionals in screening patients with eating disorders for adequate referral to a dentist. Evidence obtained from a case-control analytic study.

Patients' perception of their oral and periodontal health and its impact: a cross-sectional study in the NHS.

Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending NHS practices in South West England.Method In this cross-sectional, multi-centre epidemiological study 814 adult NHS patients completed an oral health questionnaire and then underwent a clinical examination. Pocket probing depths (mm), gingival recession (mm), gingival bleeding (yes/no), dentine hypersensitivity (Schiff score, and yes/no) and tooth wear (basic erosive wear examination score) were measured.Results Participants were regular dental attenders, with good oral hygiene practices and a low prevalence of periodontal disease (probing depth of 4 mm or more) (25%). For all conditions assessed, self-reported data and clinical indices were significantly positively associated, with the strongest associations being seen for dentine hypersensitivity and the weakest for tooth wear. Periodontal disease and dentine hypersensitivity were significantly associated with all four patient-reported measures of oral health quality of life studied.Conclusion This NHS patient population is well cared for and educated with respect to their oral health. The findings confirm the negative impact of periodontal disease and dentine hypersensitivity, and identifies the need to increase awareness of the signs and symptoms of tooth wear.

Erosive tooth wear among preschool children in Hong Kong.

This study aimed to assess the prevalence of erosive tooth wear among 3- to 5-year-old children in Hong Kong and to determine the effect of socio-economic factors, dental habits, and oral hygiene on their dental erosive wear status. Stratified random sampling was adopted. Their parents were asked to complete a questionnaire regarding their children's backgrounds. A single examiner evaluated the children for erosive tooth wear using Basic Erosive Wear Examination (BEWE) criteria. Multiple logistic regression was used to determine the relationship between erosive wear and the children's socio-economic factors, dental habits, and oral hygiene. 1204 children participated in this study. Prevalence of erosive tooth wear (BEWE score>0) was 14.9%. Among these, 153 children (12.8%) had initial wear, 21 children (1.8%) had distinct tooth loss, and five (0.4%) had severe erosive wear. Prevalence of erosive wear among the 3-, 4-, and 5-year-old children was 10.7%, 15.0%, and 17.7%, respectively. Increasing age, the low education of mother and high plaque scores were risk factors of erosive wear (P<0.05). Prevalence of erosive tooth wear is low among preschool children in Hong Kong. The erosive tooth wear prevalence increased with increasing age, lower education of mother, and poorer oral hygiene.

General and erosive tooth wear of 16-year-old adolescents in Kuantan, Malaysia: prevalence and association with dental caries

BackgroundThe objective of this study was to determine the prevalence and severity of general tooth wear (GTW), i.e. tooth wear irrespective of etiology and erosive tooth wear (ETW), i.e. tooth wear predominantly due to erosion; and also to investigate the relationship between ETW and dental caries experience in 16-year-old adolescents in Kuantan, Malaysia.MethodsA multi-staged cluster sampling method was employed. A total of 598 16-year-old adolescents participated in this study. Participants’ demographic profile was assessed through a self-administered questionnaire. Clinical examinations were carried out under standardized conditions by a single examiner. The level of GTW was recorded using the modified Smith and Knight’s Tooth Wear Index (TWI) whilst ETW were recorded using the Basic Erosive Wear Examination (BEWE) index. This index was developed to record clinical findings and assist in the decision-making process for the management of erosive tooth wear. Dental caries was recorded using the D3MFT index whereby D3 denotes obvious dental decay into dentine detected visually.ResultsThe prevalence of GTW, ETW and dental caries, i.e. percentage of individuals found to have at least one lesion, was 99.8%, 45.0% and 27.8% respectively. Two thirds of affected teeth with GTW were observed to have a TWI score of 1 whereas almost all of the affected teeth with ETW had a BEWE score of 2. The mean D3MFT was 0.62 (95% CI 0.50, 0.73) with Decayed (D) teeth being the largest component, mean D3T was 0.36 (95% CI 0.30, 0.43). There was no significant association between socio-demographic factors and prevalence of ETW. Logistic regression analysis also showed no significant relationship between the prevalence of ETW and D3MFT (p > 0.05).ConclusionsAlmost all adolescents examined had GTW but they were mainly early lesions. However, nearly half were found to have ETW of moderate severity (BEWE score 2). No significant relationship between the occurrence of erosive tooth wear and caries was observed in this population.

Tooth wear: screening, diagnosis and management in general dental practice

Recent epidemiological data shows that the prevalence of tooth wear (TW) is increasing. Current available assessment tools are either too complicated to carry out on every patient or inadequate in identifying the nature of the condition. Moreover, early onset or localized lesions may be overlooked. This article describes a screening tool which may overcome these problems. This tool involves using the existing Basic Erosive Wear Examination scoring system and a proposed age-related grid. This will lead to an associated pathway, which indicates the recommended level of further investigations and management. CPD/Clinical Relevance: Early identification and prevention of pathological tooth wear in the primary care setting is the key to slowing down the disease progression.

Erosive Tooth Wear and Related Risk Factors in 8- and 14-Year-Old Greek Children

The aim of the present study was to investigate the erosive tooth wear of primary and permanent teeth and its association with related risk factors. Two groups of Greek children aged 8 (n = 329) and 14 years (n = 263) were examined in the classroom using the Basic Erosive Wear Examination (BEWE) index. Data concerning risk factors were collected using questionnaires. Dental caries (DMFS/dmfs) was also recorded. The data were analyzed using the t test, one-way ANOVA, multiple regression analysis, Fisher's exact test, and the χ² test. In the 8-year-olds, the primary teeth showed a predominantly medium level of wear and the permanent teeth no wear. A majority of the 14-year-olds exhibited low risk levels of wear. The most frequently affected dental surface in both age groups was the occlusal surface of the mandibular posterior teeth. In the 8-year-olds, BEWE scores and the prevalence of wear in the primary teeth was influenced by gender (p = 0.020). In their permanent teeth, soft drink consumption (p < 0.0001) and preference for lemon/vinegar (p = 0.041) significantly affected wear prevalence and BEWE scores, while habitually retaining soft drinks in the mouth influenced wear prevalence (p = 0.008), risk (p = 0.004), and BEWE scores (p = 0.022). In the 14-year-olds, wear prevalence was significantly affected by the consumption of lemon-flavored candies (p = 0.016) and soft drinks (p = 0.050). BEWE scores were significantly affected by gender (p = 0.022) and soft drink consumption (p = 0.030). Gender influenced tooth wear risk in both age groups (p = 0.010 and p = 0.021, respectively). The results of this study indicate that erosive tooth wear differed between primary and permanent teeth and was influenced by gender and dietary factors.

Composition of Enamel Pellicle from Dental Erosion Patients

Oral health is dependent upon a thin mobile film of saliva on soft and hard tissues. Salivary proteins adhere to teeth to form the acquired enamel pellicle which is believed to protect teeth from acid erosion. This study investigated whether patients suffering diet-induced dental erosion had altered enamel pellicles. Thirty patients suffering erosion were compared to healthy age-matched controls. Subjects wore a maxillary splint holding hydroxyapatite and human enamel blocks for 1 h. The acquired enamel pellicle was removed from the blocks and compared to the natural incisor pellicle. Basic Erosive Wear Examination scores confirmed that dental erosion was present in erosion patients and absent from healthy age-matched controls. Erosion patients had half the amount of proteins (BCA assay) within the acquired pellicle forming on splint blocks compared to normal controls (p < 0.05). In particular, statherin, a calcium-binding protein, was 35% less abundant (p < 0.05). Calcium concentration within the acquired pellicle was also reduced by 50% in erosion patients (p < 0.001). In contrast, the natural pellicle on the incisor had similar amounts of total protein in erosion patients and healthy controls. In summary, the formation of new acquired pellicles on surfaces was reduced in erosion patients, which may explain their greater susceptibility to acid erosion of teeth.

Summary of: Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice

The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE. Cross sectional study of a sample of 164 adult patients. General dental practice in East Lancashire, UK in 2010.Subjects Patients attending for routine examination or treatment. By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established. The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κ(w) = 0.43 and 0.57 respectively). BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice

The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE. Cross sectional study of a sample of 164 adult patients. General dental practice in East Lancashire, UK in 2010. Patients attending for routine examination or treatment. By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established.Results The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κ(w) = 0.43 and 0.57 respectively). BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Tooth wear in the deciduous dentition of 5–7-year-old children: risk factors

This study was conducted to investigate the distribution and severity of tooth wear in deciduous dentition and its relationship with possible risk factors. A stratified cluster sample of 243 5-7-year-old children was examined using the tooth wear index of Smith and Knight, and their exposure to intrinsic and extrinsic risk factors was retrospectively investigated through a structured questionnaire. The severity of wear was quantitatively estimated by the number of surfaces with affected dentine and by the cumulative score of the sextants, based on the Basic Erosive Wear Examination scoring system. Only 1.6% of the children were tooth wear free, whereas 45.6% had moderate to severe wear involving dentine. Maxillary canines were the most affected teeth (83.2%), and occlusal/incisal the most affected surfaces (52.7%). The likelihood of tooth wear involving dentine was greater in boys than girls (OR = 1.72), in immigrants than in Greeks (OR = 1.93), and in 6- and 7-year olds than in 5-year olds (OR = 2.78 to 2.93). After adjustment for age, gender, and nationality, exposure to several dietary factors and especially to soft drinks was found to significantly affect the prevalence (OR = 1.27) and the severity of tooth wear. Every additional serving/week of consumption of soft drinks increases the number of surfaces with dentine affected by 0.03 per year (p < 0.05) and the cumulative score of sextants by 0.04 (p < 0.05). The cluster of children with the higher prevalence and severity of tooth wear had an average exposure to soft drinks of 10 servings/week for a duration of 4 years. The cumulative score of sextants was better predicted by the assessed risk factors, in comparison with the number of surfaces with affected dentine. Tooth wear is a common condition in children, related both to the physiological process of aging of dentition and to the erosive effect of dietary factors. Strategies to reduce the intake of soft drinks in children are expected to have multiple benefits preventing tooth wear in childhood and in later life, as well as many other general and oral health diseases.